Cardiac Catheterization
Cardiac catheterization is the passing of a catheter into the right, left, or both sides of the heart. The procedure permits measurement
of blood pressure and blood flow in the chambers of the heart to determine valve competence and cardiac wall contractility and to detect intracardiac shunts. The procedure also enables collection of blood samples and taking of diagnostic films of the ventricles (contrast ventriculography) and arteries (coronary arteriography or angiography).
of blood pressure and blood flow in the chambers of the heart to determine valve competence and cardiac wall contractility and to detect intracardiac shunts. The procedure also enables collection of blood samples and taking of diagnostic films of the ventricles (contrast ventriculography) and arteries (coronary arteriography or angiography).
Use of thermodilution catheters allows calculation of cardiac output. The purpose of the calculations is to evaluate valvular insufficiency or stenosis, septal defects, congenital anomalies, myocardial function and blood supply, and cardiac wall motion.
Cardiac catheterization should reveal no abnormalities of heart chamber size or configuration, wall motion or thickness, or direction of blood flow or valve motion; the coronary arteries should have a smooth and regular outline. Common abnormalities and defects that can be confirmed by cardiac catheterization include coronary artery disease (CAD), myocardial incompetence, valvular heart disease, and septal defects.
In left-sided heart catheterization, the catheter is inserted into the brachial or femoral artery through a puncture or cutdown procedure and, guided by fluoroscopy, is advanced retrograde through the aorta into the coronary artery ostium, the left ventricle, or both. Then a contrast medium is injected into the ventricle, permitting radiographic visualization of the ventricle and coronary arteries as well as filming (cineangiography) of heart activity.
Left-sided heart catheterization assesses the patency of the coronary arteries, mitral and aortic valve function, and left ventricular function. It aids diagnosis of left ventricular enlargement, aortic stenosis and insufficiency, aortic root enlargement, mitral insufficiency, aneurysm, and intracardiac shunt.
In right-sided heart catheterization, the catheter is inserted into an antecubital vein or into the femoral vein and advanced through the inferior vena cava or right atrium into the right side of the heart and into the pulmonary artery. Right-sided heart catheterization assesses tricuspid and pulmonic valve function and pulmonary artery pressures.
Procedure
The patient is placed in the supine position on a padded table. Electrocardiogram (ECG) leads are applied for continuous monitoring, and an I.V. line is started (if not already in place) with dextrose 5% in water or normal saline solution at a keep-vein-open rate. After the local anesthetic is injected at the catheterization site, a small incision or percutaneous puncture is made into the artery or vein, depending on whether left-side or right-side studies are to be performed, and the catheter is passed through the sheath into the vessel. The catheter is guided to the cardiac chambers or coronary arteries using fluoroscopy. When the catheter is in place, the contrast medium is injected through it to visualize the cardiac vessels and structures.
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